2. 6 y old boy of Vitamin D Deficiency B/L Genu
Valgum having Tibiofemoral angle 16 degree
Intermalleolar distance of 11cm, Q angle of
15 degree with 0-140 ROM of knee joint
Bilaterally, Flexion test- femur deformity,
Blood Inv-ALP-317/S. Calcium 8.7/S. PO4- 5.2
Rasied eosinophils
6. Varun Kumar 6y/ M from Patna
Gait- Adduction, patella centralised knee touching
knee
C/O abonormal walking/ future concern
Deformity first notice by her mother in 2019 and
progessive in nature for which patient got treatment
that time locally for 2 years and deformity get fixed.
History of vitamin D deficiency (no previous record)
for which he took one weekly sachet and calcium
syrup
No history of trauma/ infection/swelling/ burning
and pain in micturation/depression in between
thorax and abdomen
7. Birth history- mother didn’t took iron and
calcium tablet during pregnancy, rest
uneventful and normal
Developmental milestones attend
appropiately at his age group
Family History- Mother h/o hypothyroidism
since 9 years on medication
8. 2019 diagnosed with vitamin D deficiency
for which she took tab calcium and vit d
sachet
At age of 1 year left mid upper limb burn scar
mark present
9. 6 y/ M, FTNVD, C/o abnormal walking and
future concern of progression Mother noticed
deformity @ age 3 years age
Deformity progressive
No h/o trauma, infection or any swelling
F/H Mother hypothyroidsm since 9 years
10. Height 115
Weight 25
General Exam- good nutrition, no skin lesion,
no polydactyly, no short stature spinal deformity
(for Rickets/ skeletal dysplasia/multiple hereditary
exostosis)
Gait- Adduction, Knee touch each other wide space ankle
(circumduction gait)
B/L Genu valgus no patellofemoral instability
ROM normal
11. Valgum Alignment – Inward angulation of
extremity in coronal plane (Distal deviate
lateral wrt proximal)
Valgum called be deformity
depends on
Age
Degree of Valgus – 7 degree normal upto 7
year
14. Supine knee flexed touching each other both
feet medial malleoli approximated
If defomity resolve than its femur otherwise
in tibia
15. Tibio femoral angle- Clinical radiological
Intermaleolar distance- Bet medial malleoli
<5/5-10/>10
standing erect wirth hips knee fully extended
and neutral rotation with patella both knee
touching each other
Marking ASIS, centre of patella centre of ankle,
malleoli
16. Goniometer ?
Rotational Profile Assesment
Foot Progression angle
Thigh foot angle
Medial hip rotation 70
Lateral hip rotation 30
Sole of foot (straight)
?femoral anteversion/ tibial torsion
17. FPA-line of progession vs foot 10-15
external N
Thigh foot axis- 20 IR +, ER –
18. Apex @ Patella b/w ligamentum patellae and
extension of quadriceps resultant distally
Patellar instability or not
Measure – Standing/ Supine 30 flexed(patella
fixed into femoral condyle)(8-10M/15F)
25. In our patient growth potential remaining
So,Guided growth modulation
Figure of 8 plate 16mm applied B/L
Now this is standard treatment for skeletally
immature
Removal?
